Psychological and neuropsychological assessment before and after surgery for epilepsy: implications for the management of learning-disabled people

Neuropsychology Within a Tertiary Care Epilepsy Center

Epilepsy is a prevalent condition characterized by variations in its clinical presentation, etiology, and amenability to treatment. Through history, neuropsychologists have played a significant role in performing research studies on changes in language, memory, and executive functioning in patients with epilepsy, including those undergoing surgical treatment for medically refractory seizures. These studies provided a foundation for establishing neuropsychologists as critical members of interdisciplinary clinical teams specializing in evaluation and treatment of epilepsy. This article describes a number of elements of specialized neuropsychological practice that have evolved over the years within a tertiary care epilepsy center. Through diagnostic interview and objective testing, the neuropsychologist is able to provide a more complete and objective understanding of a patient's cognitive and behavioral functioning than what is obtained by other clinicians through brief office visits. While assessment of cognition, mood, and behavior is the most commonly provided service to patients with epilepsy from all age groups, there are many instances when neuropsychologists in surgical settings are called to perform more specialized procedures, including the intracarotid amytal (Wada) procedure, electrocortical stimulation mapping of language eloquent brain regions, and functional brain imaging procedures. While working as a neuropsychologist on an interdisciplinary epilepsy care team requires specialized knowledge and clinical training, it is extremely satisfying due to the diversity of the patient population and the particular challenges resulting from the often unique manner that cognition and behavior can be affected in patients with epilepsy across the lifespan.

The clinical utility of the Warrington Recognition Memory Test in people with a low IQ

The sensitivity of the Warrington Recognition Memory for Faces (RMF) to reliably localize temporal lobe dysfunction in surgical epilepsy candidates is not as strong as that of the Recognition Memory for Words (RMW). Previous research has indicated that its diagnostic utility is improved in patients with lower IQs. Data from 114 patients with unilateral hippocampal sclerosis was retrospectively examined to explore the accuracy of both subtests in patients with IQs within the low average/borderline impaired and intellectual disability ranges. In our group, the RMF did not discriminate between right and left hippocampal sclerosis, whilst the RMW did. However, many patients functioning within the intellectual disability range are unable to complete the RMW. There is a need to develop neuropsychological protocols appropriate for this group.